CAJ | 학술논문

目的：评价3种非去极化肌松药在老年患者围拔管期的残余肌松效应。方法选择2011年10月-2012年12月河北省人民医院拟行全身麻醉择期手术的老年患者150例，采用随机数字表法分为罗库溴铵组（ A组）50例、顺式阿曲库铵组（ B组）50例及维库溴铵组（ C组）50例。患者麻醉诱导前肌松监测仪监测左侧外展前臂尺神经拇内收肌收缩情况，脑电活动监测仪测定脑电双频指数（ BIS值）。麻醉诱导，患者入睡肌松监测仪定标后， A组、 B组、 C组分别静脉注射罗库溴铵、顺式阿曲库铵及维库溴铵。记录各组末次用药至拔管时间、临床时效、恢复指数，记录术毕时（ T1）、拔管时（ T2）、拔管后30 min （ T3）及拔管后1 h （ T4）4个成串刺激比值（ TOFR）＜0.7和TOFR＜0.9发生率。结果3组末次用药至拔管时间、临床时效及恢复指数比较，差异均有统计学意义（P＜0.05）；与B组比较， A组和C组末次用药至拔管时间、临床时效及恢复指数升高（ P＜0.05）。3组患者T2、 T3、 T4 TOFR＜0.7和TOFR＜0.9发生率比较，差异均有统计学意义（ P＜0.05）；与B组比较， A组和C组TOFR＜0.7和TOFR＜0.9发生率升高（P＜0.05）。结论应用顺式阿曲库铵可降低老年患者全身麻醉残余肌松发生率，降低拔管风险。
목적：평개3충비거겁화기송약재노년환자위발관기적잔여기송효응。방법선택2011년10월-2012년12월하북성인민의원의행전신마취택기수술적노년환자150례，채용수궤수자표법분위라고추안조（ A조）50례、순식아곡고안조（ B조）50례급유고추안조（ C조）50례。환자마취유도전기송감측의감측좌측외전전비척신경무내수기수축정황，뇌전활동감측의측정뇌전쌍빈지수（ BIS치）。마취유도，환자입수기송감측의정표후， A조、 B조、 C조분별정맥주사라고추안、순식아곡고안급유고추안。기록각조말차용약지발관시간、림상시효、회복지수，기록술필시（ T1）、발관시（ T2）、발관후30 min （ T3）급발관후1 h （ T4）4개성천자격비치（ TOFR）＜0.7화TOFR＜0.9발생솔。결과3조말차용약지발관시간、림상시효급회복지수비교，차이균유통계학의의（P＜0.05）；여B조비교， A조화C조말차용약지발관시간、림상시효급회복지수승고（ P＜0.05）。3조환자T2、 T3、 T4 TOFR＜0.7화TOFR＜0.9발생솔비교，차이균유통계학의의（ P＜0.05）；여B조비교， A조화C조TOFR＜0.7화TOFR＜0.9발생솔승고（P＜0.05）。결론응용순식아곡고안가강저노년환자전신마취잔여기송발생솔，강저발관풍험。
ObjectiveToobservetheeffectofresidualneuromuscularblockadeinthreedifferentnon-depolarization neuromuscularblockadeontheagedpatientsundergoinggeneralanesthesiaduringextubation.Methods 150patientsaboutto undergo general anesthesia in Hebei General Hospital from October 2011 to December 2012 were randomly divided into rocuroni-um group (group A, 50 cases), cisatracurium group (group B, 50 cases) and vecuronium (group C, 50 cases) .Muscle re-laxation monitor was used to monitor the muscle contraction in left abducens of forearm ulnar nerve , and brain electrical activity monitor was used to determine the BIS before general anaesthesia .Anaesthesia was induced by rocuronium , cisatracurium and ve-curonium in group A, B and C respectively.The time between last drug use and extubation , clinical effect and the index of recov-ery were recorded in each group .The incidence of TOFR<0.7 and TOFR<0.9 at the end of operation ( T1 ) , extubation ( T2 ) , 30 min after extubation ( T3 ) and 1 h after extubation ( T4 ) were recorded.Results The time between last time drug use and ex-tubation, clinical effect and the index of recovery in the three groups all showed statistically significant differences (P<0.05). Compared with group B , the time between last time drug use and extubation , clinical effect and the index of recovery in group A and group C were increased (P<0.05) .The incidence of TOFR<0.7 and TOFR<0.9 at T2, T3 and T4 all showed statistically significant differences ( P<0.05 ) .Compared with group B , the incidence of TOFR <0.7 and TOFR <0.9 in group A and group C were increased (P<0.05) .Conclusion The application of cisatracurium can reduce the incidence of residual neuro -muscular blockade on the elderly patients undergoing general anesthesia and reduce the risk of extubation .